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Medical sponges and towels, instruments and other items are left inside bodies during surgeries
more often than patients would imagine, up to 2,000 times a year in the United States by one
estimate.

Surgeons at Ohio State University’s Wexner Medical Center led a study in an attempt to better
understand why the problem occurs and how such incidents can be reduced.

The study was published online recently by the
Journal of the American College of Surgeons, and is scheduled to appear in print in the
January edition.

Using data from five participating academic medical centers over six years, the researchers
collected 59 instances of retained surgical instruments out of 411,526 surgeries.

In 35 of the instances, or 59 percent, the items left in patients were medical sponges or
towels.

The study found that overweight patients were at higher risk of having a surgical item left
inside them because they had more abdominal tissue.

The study confirmed that complications or unexpected events during surgery increased the risk of
items being left behind nearly 10 times. Lapsed safety precautions, such as incorrect counts of
surgical items, were associated with a risk up to 20 times higher.

For comparison, the researchers used “case-match controls” that were selected from the same or
similar surgeries that went well and without surgical items being left behind.

On the positive side, the study found that the presence of a surgical resident or other trainee
in the operating room reduced the risk of instruments being left in the patient by 70 percent.

Yet despite manual counting and even the use of radio frequency tags, which are tiny tracking
tags applied to surgical sponges, items continue to be left in patients.

“These are, thankfully, very rare events, yet this study shows there is more work to do on this
problem,” said Dr. Charles Cook, director of surgical critical care at the Wexner Medical
Center.

Cook and lead investigator Dr. Stanislaw Stawicki, a trauma surgeon and research director at the
medical center’s trauma, critical care and burn division, both lamented the lack of a national
data-collection center that would help to track the number of instances of items left in
patients.

“It’s time for a national initiative to define, track and correct these occurrences,” Cook said
in a news release.

Other surgeons agree.

Dr. Verna C. Gibbs, a professor of surgery at the University of California in San Francisco,
directs NoThing Left Behind, a national patient-safety organization she established in 2004 to help
prevent instances of retained surgical items.

Occurrences are reported by the state. However, reporting requirements vary by state, so it is
difficult to assess accurately how often the problem occurs nationwide, Gibbs wrote on the
organization’s website. It is estimated that from 1,500 to 2,000 instances occur annually
nationwide, most frequently involving cotton gauze surgical sponges measuring 4-by-4- or 18-by-18
inches.

The most-common sites where the sponges are left are the chest, abdomen, pelvic area and vagina,
although they have been left inside surgical wounds of every size and after almost any operation,
Gibbs wrote.

Retained surgical items can be discovered hours to years after an operation, and another
operation might be required for removal, she wrote. Retained items can cause infection and other
problems, and often the patient suffering symptoms is the first clue that something might have been
left behind. Items are found by X-ray.